As part of the RUC2016 Campaign the University of Calabar’ Research Uptake Communicators wrote, edited and uploaded on their Research Uptake page a plain language article that highlights how research on malaria treatment informed government policy, but where the consequent changes in policy highlighted additional challenges.

Child mortality as a result of malaria is quite alarming in areas of the world where the disease is endemic, especially in Sub-Saharan Africa. This part of the world bears about 80% of the global burden of malaria cases and 90% of global malaria deaths. Nigeria bears a significant portion of this burden of malaria. For example, in 2011, it was estimated that of the 660,000 malaria deaths, 40% of them occurred in Nigeria and the Democratic Republic of Congo.

In 2005 the federal government of Nigeria adopted the use of Artemisinin Combination Therapy (ACTs) as the first line treatment strategy for malaria illness. This was a product of research done by the lead researcher, Prof. Emmanuel U Ezedinachi of the Calabar Insitute of Tropical Diseases Research & Prevention, and others.

In some states like Cross River State, Nigeria, ACT services are now currently provided free of charge for children under five years of age and pregnant woman, yet, uptake of this free malaria treatment remains concerningly low.

"the study took records of the time it took mothers to take their children to public health facilities after those children started to show signs of malaria; and also recorded reasons for any delays"

For effective prevention of transformation of malaria from uncomplicated malaria cases, to severe ones that usually cause death, especially in children aged five years and below, ACTs have to be given promptly, within 24 hours of onset of malaria symptoms.

Researchers at the University of Calabar Nigeria, investigated the malaria treatment-seeking behaviour of mothers (primary caregivers) when their children develop symptoms of malaria illness. Caregivers from the Akpabuyo Local Government Area of Cross River State, a rural community, were invited to come to public health facilities where laboratory tests for malaria and treatment with ACTs were given free of charge. Specifically, the study took records of the time it took mothers to take their children to public health facilities after those children started to show signs of malaria; and also recorded reasons for any delays.

The results showed that most mothers (82%) were late in initiating effective malaria treatment (ACTs) at public health facilities. The delay was up to 168 hours (about seven days) after the children first showed signs of malaria. The main question that could then be asked after considering the results of the research, is why these reasons for delay when the drugs (ACTs) and tests were free of charge? Moreover, these public health centres were also staffed by skilled personnel.

The reasons given by mothers for the delay were lack of finance to pay for medical charges (74%) and lack of transportation fare (18%), as well as a lack of knowledge of the free service and awareness of the importance of immediate treatment.

"government and other stakeholders need to do more to understand and alleviate the day to day effect of being very poor"

Mitigating the delays

The results showed that the caregivers needed health education on the grave dangers of delay in initiating effective antimalarial treatment, including accurate information about how to access effective antimalarial treatment. Although provision of ACTs is free, caregivers reported that they didn’t know this, and they did not have transport fare to get to the public health facilities, indicating that government and other stakeholders need to do more to understand and alleviate the day to day effect of being very poor.

Future policy and practice direction

The research suggests that there are re-enforcing inter-plays between poverty, lack of knowledge, and malaria infection. Therefore, empowering women with limited access to knowledge and resources in multiple ways, including education about their right to public health support, providing the transport vouchers that would allow them to seek timely treatment for malaria treatment and dissemination of research findings in formats that are appropriate for poor, perhaps illiterate women. Appropriate interventions for poor women and their children may represent dividend-yielding investment with a beneficial multiplier effect on overall development of the nation.

The original article “Malaria: The Big Picture. … malaria control and poverty reduction are reciprocal”is published on the University of Calabar website. You can find it here

This article is a Research Uptake Communication collaboration between the University of Calabar Research Uptake Communicators, Dr Regina Idu Ejemot-Nwadiaro, and Dr Joshua Pam Mwankon, and the Lead Researcher, Prof. Emmanuel U, Ezedinachi

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